ADHD: Managing ADHD medications

Summary: Although ADHD medications may be helpful for symptoms of ADHD, they can cause side effects. This handout has some suggestions that may help you manage these side effects so your child can get the most benefit from stimulant medication (e.g.methylphenidate (Ritalin®, Ritalin SR®, Biphentin®, Concerta® and amphetamine-based treatments (Dexedrine®, Dexedrine Spansules®, Adderall XR®, Vyvanse®).

General Considerations

In order to ensure that there are no medical explanations for AD/HD, and no medical reasons that would make treating your child with stimulant medications risky, your doctor may ask for a physical examination form to be completed by your family doctor.

Stimulant medication is usually started at a low dose and increased slowly each week. Your doctor may ask to get teacher checklists to see how your child is responding to medication, and the minimum dose needed to obtain a reasonable response. Make sure you leave the doctor’s office with the prescription and the checklist.

If requested by your doctor, give the teacher a checklist immediately to describe how your child has been functioning. Date the checklist and write the medication name (and dosage) on the form. Given the teacher a checklist either at each new dose, or for the week prior to your return appoint as per your doctors instructions. ALWAYS bring the checklist with you to your appointment. Never email, fax or mail the checklists in.

All children are different in terms of the medication dose that is right for them. If your child is doing fine and having no response and no side effects the doctor will increase the dose. If you get to a dose in which your child is responding but also the side effects are causing significant problems, the doctor will either stay at that dose until the side effects abate or lower the dose. Follow your doctor’s specific directions regarding how to take your medication.

Parents often ask how much is too much with regard to side effects. You may need to reduce the dose of the medication or stop the medication until your next visit if the following occur:

Your child is too quiet, has lost their sparkle or personality, has dilated pupils or seems “zombie-like”

Your child is rapidly losing weight and not eating

If it is taking more than 1 hour to fall asleep or your child is getting less than 8½ hours of sleep a night

If for any reason you need to stop taking this medication it can be stopped abruptly. The only likely difficulty is a return of AD/HD symptoms. If you do stop the medication, make sure to return to see your doctor to discuss the difficulty which led you to stop taking the medication. You may wish to consider stopping the medication temporarily when your child is not in school (e.g. during holidays, summer break – this is sometimes called a “drug holiday”). This may be done to see if you still need to take the medication, promote growth, and to prevent the body from getting too used to the medication. However, if your child has been off of stimulant medication for an extended period of time, they need to restart medication by increasing the dose gradually as tolerated.

Managing Appetite

Stimulant medication strongly lowers appetite. This can be explained to children by saying:

“The medicine does a trick on your brain. It makes you think you are not hungry, but your body really is hungry. If you don’t feed it, you might get a headache, or a stomach ache, or feel cranky and tired, so it’s really important to eat. If you do get a headache or stomach ache the first thing you should do is eat or drink something.”

While starting treatment with a stimulant medication, some children will lose weight.

If weight loss is a problem however, the good news is that there are techniques have been developed over the years, and can prevent weight loss, both in the short- and long-term.

Children with AD/HD do not sit at the table and eat a meal. They find this boring and if eating is associated with sitting still they will avoid eating. Therefore let them “graze” eating on the go, or while they do something else like watch TV. This means that the usual rules families have may be problematic for AD/HD children. For example, in many families if you don’t eat your supper you can’t eat later.

Since appetite is reduced by the medication, most of the eating your child does will be at breakfast before taking medication, and in the evening after the medication wears off.

We want to encourage children to eat as much as possible, whenever they are hungry. Some families also have concerns about eating late at night. “Second supper” or giving a full meal with fat, protein, carbohydrate (not a snack) when the medication wears off and the child experiences a rebound of appetite right before falling asleep allows them to make up at night all the calories they lost during the day. “Second supper” should become routine. If the child is also taking melatonin for sleep, they can be given together.

Since this puts a lot of demands on the parent, have the “second supper” and nutritious snack pre-prepared. They can be frozen and then thawed out as needed to provide variety.

Try meal replacement supplements, such as Boost® or Ensure®. If your child has something salty at recess or lunch he or she will be thirsty and these can be consumed quickly but are a full meal replacement with vitamins, minerals, fat, carbohydrate and protein. Meal replacements come in many forms, including pudding, and are available at any pharmacy or grocery store. If your child doesn’t like commercially available flavors/varieties, try making smoothies at home as a substitute.

Switch to using homogenized milk.

While children can enjoy dessert, do not allow them to eat candy or pop right before a meal, since it can reduce their appetite for eating nutritionally balanced food later.

Many schools have a procedure at lunch time in which children are given free time or allowed outside to play “after they finish their lunch”. This leads many children, and especially AD/HD children, to throw out their lunch and go play. As part of an Individual Education Plan it is very helpful to have the lunch monitor (usually an older child) ensure that the child has some lunch, or drinks a Boost/Ensure, and has something to drink.

Managing Sleep

AD/HD is associated with an increased risk for sleep difficulties:

Children with AD/HD are much more likely to have “difficulty turning their thoughts oft” and falling asleep.

They may be more tired during the day even when they are active, and they may experience “restless legs syndrome” which is a feeling of needing to move the legs before falling asleep.

Many children with AD/HD have a history of sleep problems even before starting stimulant medications, and stimulant medication can make these difficulties worse.

Good sleep habits and other measures are essential to correcting sleep problems, which can cause as much difficulty as the AD/HD itself.

Your child’s brain eventually gets trained to go to sleep at the same time every day and wake up at the same time every day. This is called “circadian rhythm”. The sleep clock is set in the morning. If you want your child to go to bed early Sunday night, wake him up early Sunday morning. A sleep schedule should be worked out with you, your child and your doctor. Most children need about 9½ hours of sleep per night. This means your child needs to avoid sleeping in on the weekend and avoid changes in sleep routines for children that are living in different households.

Screen activities (television, video games, computer games, DS, play station, mobile phones) should not take place after supper. They are a source of bright light which suppresses melatonin, the natural hormone that produces sleepiness normally. AD/HD children often have difficulty falling asleep and have a 90 minute delay in the release of melatonin. Gaming in particular tends to “rev” up the brain and has an addictive quality for many AD/HD children, which not only makes it hard to turn the game off, but leaves the child highly alert and resistant to going to bed. Remove all electronics form your child at night, including mobile phones, to prevent a common but harmful habit that has developed in which children are texting each other at night.

Some children have to be off stimulants when they go to sleep and will need stimulant medication just for school hours, so that by the time they go to bed it is six hours after medication has left the body. The time when it is most difficult to induce sleep is when a child is in “rebound”. Rebound means that for some children when the medication wears off they feel edgy, irritable, reactive or agitated. Paradoxically, it should be noted that some children fall asleep better when they are on a low dose of stimulant medication.

The only medication which has research evidence to support its efficacy for sleep in AD/HD children is melatonin. Melatonin has been studied in several countries with long term follow-up. Since children with AD/HD are deﬁcient in the release of melatonin, which is on the same brain pathway as AD/HD itself, taking melatonin is in some ways similar to how insulin works for diabetes: melatonin provides something the body normally makes itself. As a result, there are few, if any side effects. We recommend you purchase a pharmaceutical grade melatonin product [ask the pharmacist for a brand with a “DIN” number] and give your child 3 to 6 mg of melatonin 30 minutes before bedtime. This usually solves sleep issues, but if difficulties with sleep continue, further interventions may be recommended by your doctor.

About this document

Special thanks to the Kelty Centre for Mental Health for permission to adapt this document. The original document was developed by health professionals of BC Mental Health and Addiction Services, and reviewed by the staff of the Kelty Mental Health Centre. French translation provided courtesy of the Ontario Centre of Excellence for Child and Youth Mental Health.

Creative Commons license

You are free to copy and distribute this material unchanged and in its entirety as long as 1) this material is not used in any way that suggests we endorse you or your use of the material, 2) this material is not used for commercial purposes (non-commercial), 3) this material is not altered in any way (no derivative works). View full license at http://creativecommons.org/licenses/by-nc-nd/2.5/ca/. For any other uses, please contact the original rights holder, the Kelty Mental Health Centre.

Disclaimer

Information in this pamphlet is offered ‘as is' and is meant only to provide general information that supplements, but does not replace the information from your health provider. Always contact a qualified health professional for further information in your specific situation or circumstance.

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1. Attention-Deficit Hyperactivity Disorder (ADHD)
This is the most common type, causing troubles with attention and hyperactivity. Typical symptoms of ADHD:
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Medication Information

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What medications are used to treat ADHD?
Attention deficit/hyperactivity disorder (ADHD) occurs in both children and adults. ADHD is commonly treated with stimulants, such as:
Methylphenidate (Ritalin, Metadate, Concerta, Daytrana)
Amphetamine (Adderall)
Dextroamphetamine (Dexedrine, Dextrostat).
In 2002, the FDA approved the nonstimulant medi...

Attention deficit/hyperactivity disorder (ADHD) occurs in both children and adults. ADHD is commonly treated with stimulants, such as:

Methylphenidate (Ritalin, Metadate, Concerta, Daytrana)

Amphetamine (Adderall)

Dextroamphetamine (Dexedrine, Dextrostat).

In 2002, the FDA approved the nonstimulant medication atomoxetine (Strattera) for use as a treatment for ADHD. In February 2007, the FDA approved the use of the stimulant lisdexamfetamine dimesylate (Vyvanse) for the treatment of ADHD in children ages 6 to 12 years.

What are the side effects?

Most side effects are minor and disappear when dosage levels are lowered. The most common side effects include:

Decreased appetite. Children seem to be less hungry during the middle of the day, but they are often hungry by dinnertime as the medication wears off.

Sleep problems. If a child cannot fall asleep, the doctor may prescribe a lower dose. The doctor might also suggest that parents give the medication to their child earlier in the day, or stop the afternoon or evening dose. To help ease sleeping problems, a doctor may add a prescription for a low dose of an antidepressant or a medication called clonidine.

Stomachaches and headaches.

Less common side effects. A few children develop sudden, repetitive movements or sounds called tics. These tics may or may not be noticeable. Changing the medication dosage may make tics go away. Some children also may appear to have a personality change, such as appearing "flat" or without emotion. Talk with your child's doctor if you see any of these side effects.

How are ADHD medications taken?

Stimulant medications can be short-acting or long-acting, and can be taken in different forms such as a pill, patch, or powder. Long-acting, sustained and extended release forms allow children to take the medication just once a day before school. Parents and doctors should decide together which medication is best for the child and whether the child needs medication only for school hours or for evenings and weekends too.

ADHD medications help many children and adults who are hyperactive and impulsive. They help people focus, work, and learn. Stimulant medication also may improve physical coordination. However, different people respond differently to medications, so children taking ADHD medications should be watched closely.

Are ADHD medications safe?

Stimulant medications are safe when given under a doctor's supervision. Some children taking them may feel slightly different or "funny."

Some parents worry that stimulant medications may lead to drug abuse or dependence, but there is little evidence of this. Research shows that teens with ADHD who took stimulant medications were less likely to abuse drugs than those who did not take stimulant medications.14

FDA warning on possible rare side effects

In 2007, the FDA required that all makers of ADHD medications develop Patient Medication Guides. The guides must alert patients to possible heart and psychiatric problems related to ADHD medicine. The FDA required the Patient Medication Guides because a review of data found that ADHD patients with heart conditions had a slightly higher risk of strokes, heart attacks, and sudden death when taking the medications. The review also found a slightly higher risk (about 1 in 1,000) for medication-related psychiatric problems, such as hearing voices, having hallucinations, becoming suspicious for no reason, or becoming manic. This happened to patients who had no history of psychiatric problems.

The FDA recommends that any treatment plan for ADHD include an initial health and family history examination. This exam should look for existing heart and psychiatric problems.

The non-stimulant ADHD medication called atomoxetine (Strattera) carries another warning. Studies show that children and teenagers with ADHD who take atomoxetine are more likely to have suicidal thoughts than children and teenagers with ADHD who do not take atomoxetine. If your child is taking atomoxetine, watch his or her behavior carefully. A child may develop serious symptoms suddenly, so it is important to pay attention to your child's behavior every day. Ask other people who spend a lot of time with your child, such as brothers, sisters, and teachers, to tell you if they notice changes in your child's behavior. Call a doctor right away if your child shows any of the following symptoms:

Acting more subdued or withdrawn than usual

Feeling helpless, hopeless, or worthless

New or worsening depression

Thinking or talking about hurting himself or herself

Extreme worry

Agitation

Panic attacks

Trouble sleeping

Irritability

Aggressive or violent behavior

Acting without thinking

Extreme increase in activity or talking

Frenzied, abnormal excitement

Any sudden or unusual changes in behavior.

While taking atomoxetine, your child should see a doctor often, especially at the beginning of treatment. Be sure that your child keeps all appointments with his or her doctor.

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School Letter

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I am writing to give you an update regarding your student, who has a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) / Attention Deficit Disorder (ADD).
Accommodations are essential for this student to function in the academic program. Specific accommodations will need to be devised for this student in collaboration with the youth and family.
There are...

I am writing to give you an update regarding your student, who has a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) / Attention Deficit Disorder (ADD).

Accommodations are essential for this student to function in the academic program. Specific accommodations will need to be devised for this student in collaboration with the youth and family.

There are many ways that schools can help a child with ADHD succeed in the classroom. Meetings between parents and school staff, such as teachers, guidance counselors, or nurses, will allow for collaboration to develop helpful school structure for the child. The child may need particular changes (accommodations/modifications) within a classroom. Examples of some accommodations, modifications, and school strategies include the following options.

For children with inattentive symptoms:

Assign the child a seat that limits distractions. Sitting at the front of the class may be helpful.

Reduce distracting sounds. Noisy classroom chairs can be quieted with tennis balls or padding at the end of the legs. Headphones may help a child’s concentration.

Clarify the expectations for classroom behaviors. If children understand, ahead of time, what is expected of them and what the consequences are if expectations are not met, they will have a better chance at succeeding.

Clearly draw attention to instructions that are given (for example, “Peter, this is a direction”). A child with ADHD often misses basic social cues.

Ask the child to repeat instructions before carrying them out. Repetition reinforces the directions in the child’s mind and makes evident whether the child understood the instructions.

Provide information in small chunks that will allow the child to follow each step

Provide frequent check-in points during a lesson. Children with ADHD will respond well to supervision and encouragement that help keep them on track.

Develop simple, discreet visual cues to help a child return to on-task behaviors. Children respond well to helpful reminders that do not embarrass them.

Adjust to the child’s learning style. Untimed tests may be needed. For other tasks, a timer may help a child track the time needed to complete an assignment.

Develop motivating strategies to complete assignments. By pairing easier tasks that a child prefers with more difficult tasks, a child will have more enthusiasm for all tasks.

Help the child remember and retain important class materials. Write a list of needed class materials and develop a means for getting the list home (for example, tape it to a book or help the child place it in a backpack). Having a complete set of classroom materials at home and at school reduces time lost tracking down items such as pencils, erasers, paper, and textbooks. Taping important items such as pencils to the desk may reduce lost items.

Help the child keep track of assignments by emailing assignments home

For the child with hyperactive or impulsive symptoms:

Identify appropriate times/places when the child can move (for example, ask the child to bring the attendance sheet to the office). Children with ADHD may need to move more frequently than other children.

Provide an alternative, less distracting source of activity, such as a squeezeball or fabric to rub.

Develop cues to help students stop talking out of turn. Nonverbal cues can be powerful and effective for all students. Identify when the child will be able to talk again. For students who blurt out answers, encourage them to write down answers before raising their hands to give answers.

Before an activity, clarify expectations. Identifying the expected volume level and activity level before unstructured activities will help reinforce desired behaviors.

Design interventions that interrupt the behaviors. For a child with trouble standing in line, assign the child to a specific place to stand in line, or a specific student to stand beside. For a child with difficulty with taking turns, develop a routine for waiting, such as counting to 5, and then raising a hand.

For all children with ADHD:

Provide assistance with peer interactions. An adult’s help may be very beneficial for both the child and his or her peers.

Encourage small group interactions to develop increased areas of competency. Children with ADHD may put forth better efforts in more contained groups.

Encourage the child to help develop interventions. Enlisting the child in the task will lead to more successful strategies and will foster the child’s ability to problem-solve.

Develop a behavior plan that is a true incentive to the student, as described above in Interventions at Home. Rewards may be given at school by a teacher or school counselor or at home by a parent. Teachers, school counselors, and parents can collaborate to use similar reward systems at school and home.

Reward a child’s efforts. Every good effort deserves to be praised.

Special thanks to Dr. Bostic and the School Psychiatry Program and the MADI Resource Center for permission to use this content.

Workplace Accommodation

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To whom it may concern:
I am writing this letter to let you know that this employee requires accommodations and modifications in the workplace.
Specific accommodations and modifications will need to be determined after speaking further with this employee.
Nonetheless, here are some specific areas and possible strategies:
Time Managemen...

I am writing this letter to let you know that this employee requires accommodations and modifications in the workplace.

Specific accommodations and modifications will need to be determined after speaking further with this employee.

Nonetheless, here are some specific areas and possible strategies:

Time Management

This employee may experience difficulty managing time, which can make it hard for this person to get tasks completed on time.

Possible strategies include

When you have an assignment for this employee

Give several small tasks instead (rather than just giving one big task)

When the employee is working on a task that is expected to take a specific amount of time, consider giving the employee a timer with an alarm that goes off after a reasonable time, to help remind the employee to stay on task

Provide a checklist of assignments

Supply an electronic or handheld organizer, and train on how to use effectively

Use wall calendar to emphasize due dates

Develop a color-coded system (each color represents a task, or event, or level of importance)

Allow co-worker or supervisor to add entries on the calendar, or to double-check entries added by the employee with AD/HD

Memory

This employee may have memory problems, which makes it hard to complete tasks, as well as troubles remembering job duties.

Possible strategies

Provide written instructions

Allow additional training time for new tasks

Offer training refreshers

Use flow-chart to indicate steps in a task

Provide verbal or pictorial cues

Use post-it notes as reminders of important dates or tasks

Concentration

This employee may have troubles concentrating and focusing on ‘boring tasks’

Possible strategies

If possible, put this employee in a workspace that has less noise

Consider a white noise machine, or background music

To reduce visual distractions:

Install space enclosures (cubicle walls)

Reduce clutter in the employee’s work environment

Redesign employee’s office space to minimize visual distractions

Relocate employee’s office space away from visual distractions

Organization and Prioritization

This employee may have difficulty getting or staying organized, or have difficulty prioritizing tasks at work.

Possible strategies

Help the employee develop some sort of organization system

Develop color-code system for files, projects, or activities

Use weekly chart to identify daily work activities

Use the services of a professional organizer

Use a job coach to teach/reinforce organization skills

Assign a mentor to help employee

Allow supervisor to assign prioritization of tasks

Assign new project only when previous project is complete, when possible

Use role-play scenarios to demonstrate appropriate behavior in workplace

Hyperactivity/Impulsivity

Individuals may have an extremely high level of activity, and may even have troubles sitting still

Possible strategies

Within the work environment, give the employee opportuntiies to stand and move, rather than insisting on simply sitting still

Consider standing desks (desk where the employee can stand up rather than just sit), or sit-stand stations (workstation that can be lowered so an employee can sit down, or can be raised so that the employee can stand up).

Give frequent movement breaks

Multi-tasking

Individuals with AD/HD may experience difficulty performing many tasks at one time. This difficulty could occur regardless of the similarity of tasks or the frequency of performing the tasks.

Possible strategies

Separate tasks so that each can be completed one at a time

Create a flow-chart of tasks that must be performed at the same time, carefully labeling or color-coding each task in sequential or preferential order

Provide individualized/specialized training to help employee learn techniques for multi-tasking (e.g., typing on computer while talking on phone)

Identify tasks that must be performed simultaneously and tasks that can be performed individually

Provide specific feedback to help employee target areas of improvement

Remove or reduce distractions from work area

Supply ergonomic equipment to facilitate multi-tasking

Clearly represent performance standards such as completion time or accuracy rates

Paperwork

Individuals may experience difficulty completing paperwork efficiently and effectively. Because paperwork is usually boring, it means that while doing paperwork, the brain of the person with ADHD is not getting enough stimulation.

Strategies include:

Doing paperwork during the employee’s “peak periods”, e.g. early morning, late afternoon, etc.

Examples of Common Workplace Accommodations
Accommodations should be based on your needs and the employer’s resources. There is no standard list of reasonable accommodations, but here is a list of commonly provided workplace accommodations:
Job coach assistance in hiring and on the job mentoring as necessary. Job coach/mentor could be from an external agency or be f...

Accommodations should be based on your needs and the employer’s resources. There is no standard list of reasonable accommodations, but here is a list of commonly provided workplace accommodations:

Job coach assistance in hiring and on the job mentoring as necessary. Job coach/mentor could be from an external agency or be from within the organization.

Flexible scheduling to accommodate effects of medications, time for appointments, more frequent breaks, switch to temporary part-time hours without fear of losing job.

Changes in supervision, for example how feedback and instruction are given, or having weekly supervision appointments to check in and prevent problems before they can happen.

In training, allowing more time for tasks to be learned, or allowing for individualized, one-on-one training.

Appropriate technology like a tape recorder to tape instructions, head phones to block out loud noise, etc.

Modifying work space or changing location so it is quieter, fewer distractions; allowing an employee to work at home.

Allowing an employee to exchange minor job tasks with others.

Rights and Responsibilities of the Employer & Employee

The Employer Should:

Create and maintain an atmosphere where people feel comfortable asking for accommodation, including providing information about the organization’s policies and creating ways for requests to happen confidentially.

Assume that the employee’s request for accommodation is made in good faith.

In a timely manner, work with the employee (and a professional, if necessary), to explore all options for accommodation.

Maintain records of the request and steps taken to deal with the request.

Maintain and respect confidentiality issues.

Pay the cost of the accommodations, including fees for any medical certificates required.

Request only information that is directly related to developing an appropriate accommodation.

Ensure that managers and supervisory staff will not tolerate any discrimination or harassment as a result of an illness or an accommodation.

The Employee Should

Tell the employer you need an accommodation, due to a disability, and give them the information they need to understand what the limitations are and what accommodations would address them.

The Canadian Alliance for Monitoring Effectiveness and Safety of Antipsychotics in Children (CAMESA) guidelines provide parents and doctors with information about the side effects of antipsychotic drugs in children.

The Centre of Knowledge on Healthy Child Development gives you access to important and up-to-date information that is based on the best scientific research currently available. It's designed to help you sort through all the conflicting information about what promotes, and what hinders, healthy child development so you can make better choices that will result in better outcomes for children.

Non-profit, parent-run organization with chapters throughout the country that provides:
* Support and education for those with ADHD, for those who care for them.
* Sponsors workshops, presentations and conferences on the latest breakthroughs and techniques involved in dealing with
ADHD.

Attending college or university opens up an exciting world of possibilities. It can also be pretty challenging. But if you’re living with a mental illness, you’ve faced challenges before. This resource is designed to make your transition to college or university just a little bit easier. It takes you through all the steps of going to school, providing information and tips for anyone living with a mental illness.

Iris the Dragon is a charity which creates educational material for adults and young readers to help facilitate a conversation between parents, teachers and children about issues relating to mental health and wellness. Now approved by the Departments of Education for the Province of Manitoba and Nova Scotia as acceptable resource material for their mental health curriculum, Iris the Dragon's books address a variety of emotional, behavioural and neurodevelopmental conditions and recognize the importance of family, school, and community in promoting the potential of every child and youth, regardless of mental health challenge.

The keys to taking care of youth mental health are to work towards building close and genuinely supportive relationships and promoting mental wellness, and to get help early should problems arise. This free guide was designed to help parents forge and strengthen those connections and support their youth's mental health.

OurHealthyMinds is about mental health. It celebrates the many ways we can be well, and honours the many ways we can experience mental illness - as an individual, a caregiver, a parent, a child or loved one.

Provides teachers and other education professionals with resources and materials that have been developed specifically to bridge the substantial gap between current neuroscientific understanding of ADHD and classroom practice.

Canadian guidelines on pharmacotherapy for disruptive and aggressive behaviour in children and adolescents with attention-deficit hyperactivity disorder, oppositional defiant disorder, or conduct disorder.

Published

2015

Produced By

Canadian Journal of Psychiatry

Ages Served

Up to 18 years

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Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/ Hyperactivity Disorder

School Letter

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I am writing to give you an update regarding your student, who has a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) / Attention Deficit Disorder (ADD).
Accommodations are essential for this student to function in the academic program. Specific accommodations will need to be devised for this student in collaboration with the youth and family.
There are...

I am writing to give you an update regarding your student, who has a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) / Attention Deficit Disorder (ADD).

Accommodations are essential for this student to function in the academic program. Specific accommodations will need to be devised for this student in collaboration with the youth and family.

There are many ways that schools can help a child with ADHD succeed in the classroom. Meetings between parents and school staff, such as teachers, guidance counselors, or nurses, will allow for collaboration to develop helpful school structure for the child. The child may need particular changes (accommodations/modifications) within a classroom. Examples of some accommodations, modifications, and school strategies include the following options.

For children with inattentive symptoms:

Assign the child a seat that limits distractions. Sitting at the front of the class may be helpful.

Reduce distracting sounds. Noisy classroom chairs can be quieted with tennis balls or padding at the end of the legs. Headphones may help a child’s concentration.

Clarify the expectations for classroom behaviors. If children understand, ahead of time, what is expected of them and what the consequences are if expectations are not met, they will have a better chance at succeeding.

Clearly draw attention to instructions that are given (for example, “Peter, this is a direction”). A child with ADHD often misses basic social cues.

Ask the child to repeat instructions before carrying them out. Repetition reinforces the directions in the child’s mind and makes evident whether the child understood the instructions.

Provide information in small chunks that will allow the child to follow each step

Provide frequent check-in points during a lesson. Children with ADHD will respond well to supervision and encouragement that help keep them on track.

Develop simple, discreet visual cues to help a child return to on-task behaviors. Children respond well to helpful reminders that do not embarrass them.

Adjust to the child’s learning style. Untimed tests may be needed. For other tasks, a timer may help a child track the time needed to complete an assignment.

Develop motivating strategies to complete assignments. By pairing easier tasks that a child prefers with more difficult tasks, a child will have more enthusiasm for all tasks.

Help the child remember and retain important class materials. Write a list of needed class materials and develop a means for getting the list home (for example, tape it to a book or help the child place it in a backpack). Having a complete set of classroom materials at home and at school reduces time lost tracking down items such as pencils, erasers, paper, and textbooks. Taping important items such as pencils to the desk may reduce lost items.

Help the child keep track of assignments by emailing assignments home

For the child with hyperactive or impulsive symptoms:

Identify appropriate times/places when the child can move (for example, ask the child to bring the attendance sheet to the office). Children with ADHD may need to move more frequently than other children.

Provide an alternative, less distracting source of activity, such as a squeezeball or fabric to rub.

Develop cues to help students stop talking out of turn. Nonverbal cues can be powerful and effective for all students. Identify when the child will be able to talk again. For students who blurt out answers, encourage them to write down answers before raising their hands to give answers.

Before an activity, clarify expectations. Identifying the expected volume level and activity level before unstructured activities will help reinforce desired behaviors.

Design interventions that interrupt the behaviors. For a child with trouble standing in line, assign the child to a specific place to stand in line, or a specific student to stand beside. For a child with difficulty with taking turns, develop a routine for waiting, such as counting to 5, and then raising a hand.

For all children with ADHD:

Provide assistance with peer interactions. An adult’s help may be very beneficial for both the child and his or her peers.

Encourage small group interactions to develop increased areas of competency. Children with ADHD may put forth better efforts in more contained groups.

Encourage the child to help develop interventions. Enlisting the child in the task will lead to more successful strategies and will foster the child’s ability to problem-solve.

Develop a behavior plan that is a true incentive to the student, as described above in Interventions at Home. Rewards may be given at school by a teacher or school counselor or at home by a parent. Teachers, school counselors, and parents can collaborate to use similar reward systems at school and home.

Reward a child’s efforts. Every good effort deserves to be praised.

Special thanks to Dr. Bostic and the School Psychiatry Program and the MADI Resource Center for permission to use this content.

Workplace Accommodation

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To whom it may concern:
I am writing this letter to let you know that this employee requires accommodations and modifications in the workplace.
Specific accommodations and modifications will need to be determined after speaking further with this employee.
Nonetheless, here are some specific areas and possible strategies:
Time Managemen...

I am writing this letter to let you know that this employee requires accommodations and modifications in the workplace.

Specific accommodations and modifications will need to be determined after speaking further with this employee.

Nonetheless, here are some specific areas and possible strategies:

Time Management

This employee may experience difficulty managing time, which can make it hard for this person to get tasks completed on time.

Possible strategies include

When you have an assignment for this employee

Give several small tasks instead (rather than just giving one big task)

When the employee is working on a task that is expected to take a specific amount of time, consider giving the employee a timer with an alarm that goes off after a reasonable time, to help remind the employee to stay on task

Provide a checklist of assignments

Supply an electronic or handheld organizer, and train on how to use effectively

Use wall calendar to emphasize due dates

Develop a color-coded system (each color represents a task, or event, or level of importance)

Allow co-worker or supervisor to add entries on the calendar, or to double-check entries added by the employee with AD/HD

Memory

This employee may have memory problems, which makes it hard to complete tasks, as well as troubles remembering job duties.

Possible strategies

Provide written instructions

Allow additional training time for new tasks

Offer training refreshers

Use flow-chart to indicate steps in a task

Provide verbal or pictorial cues

Use post-it notes as reminders of important dates or tasks

Concentration

This employee may have troubles concentrating and focusing on ‘boring tasks’

Possible strategies

If possible, put this employee in a workspace that has less noise

Consider a white noise machine, or background music

To reduce visual distractions:

Install space enclosures (cubicle walls)

Reduce clutter in the employee’s work environment

Redesign employee’s office space to minimize visual distractions

Relocate employee’s office space away from visual distractions

Organization and Prioritization

This employee may have difficulty getting or staying organized, or have difficulty prioritizing tasks at work.

Possible strategies

Help the employee develop some sort of organization system

Develop color-code system for files, projects, or activities

Use weekly chart to identify daily work activities

Use the services of a professional organizer

Use a job coach to teach/reinforce organization skills

Assign a mentor to help employee

Allow supervisor to assign prioritization of tasks

Assign new project only when previous project is complete, when possible

Use role-play scenarios to demonstrate appropriate behavior in workplace

Hyperactivity/Impulsivity

Individuals may have an extremely high level of activity, and may even have troubles sitting still

Possible strategies

Within the work environment, give the employee opportuntiies to stand and move, rather than insisting on simply sitting still

Consider standing desks (desk where the employee can stand up rather than just sit), or sit-stand stations (workstation that can be lowered so an employee can sit down, or can be raised so that the employee can stand up).

Give frequent movement breaks

Multi-tasking

Individuals with AD/HD may experience difficulty performing many tasks at one time. This difficulty could occur regardless of the similarity of tasks or the frequency of performing the tasks.

Possible strategies

Separate tasks so that each can be completed one at a time

Create a flow-chart of tasks that must be performed at the same time, carefully labeling or color-coding each task in sequential or preferential order

Provide individualized/specialized training to help employee learn techniques for multi-tasking (e.g., typing on computer while talking on phone)

Identify tasks that must be performed simultaneously and tasks that can be performed individually

Provide specific feedback to help employee target areas of improvement

Remove or reduce distractions from work area

Supply ergonomic equipment to facilitate multi-tasking

Clearly represent performance standards such as completion time or accuracy rates

Paperwork

Individuals may experience difficulty completing paperwork efficiently and effectively. Because paperwork is usually boring, it means that while doing paperwork, the brain of the person with ADHD is not getting enough stimulation.

Strategies include:

Doing paperwork during the employee’s “peak periods”, e.g. early morning, late afternoon, etc.

Examples of Common Workplace Accommodations
Accommodations should be based on your needs and the employer’s resources. There is no standard list of reasonable accommodations, but here is a list of commonly provided workplace accommodations:
Job coach assistance in hiring and on the job mentoring as necessary. Job coach/mentor could be from an external agency or be f...

Accommodations should be based on your needs and the employer’s resources. There is no standard list of reasonable accommodations, but here is a list of commonly provided workplace accommodations:

Job coach assistance in hiring and on the job mentoring as necessary. Job coach/mentor could be from an external agency or be from within the organization.

Flexible scheduling to accommodate effects of medications, time for appointments, more frequent breaks, switch to temporary part-time hours without fear of losing job.

Changes in supervision, for example how feedback and instruction are given, or having weekly supervision appointments to check in and prevent problems before they can happen.

In training, allowing more time for tasks to be learned, or allowing for individualized, one-on-one training.

Appropriate technology like a tape recorder to tape instructions, head phones to block out loud noise, etc.

Modifying work space or changing location so it is quieter, fewer distractions; allowing an employee to work at home.

Allowing an employee to exchange minor job tasks with others.

Rights and Responsibilities of the Employer & Employee

The Employer Should:

Create and maintain an atmosphere where people feel comfortable asking for accommodation, including providing information about the organization’s policies and creating ways for requests to happen confidentially.

Assume that the employee’s request for accommodation is made in good faith.

In a timely manner, work with the employee (and a professional, if necessary), to explore all options for accommodation.

Maintain records of the request and steps taken to deal with the request.

Maintain and respect confidentiality issues.

Pay the cost of the accommodations, including fees for any medical certificates required.

Request only information that is directly related to developing an appropriate accommodation.

Ensure that managers and supervisory staff will not tolerate any discrimination or harassment as a result of an illness or an accommodation.

The Employee Should

Tell the employer you need an accommodation, due to a disability, and give them the information they need to understand what the limitations are and what accommodations would address them.